Provider Demographics
NPI:1609185784
Name:BRIDGMAN, CAROL ANN
Entity Type:Individual
Prefix:
First Name:CAROL ANN
Middle Name:
Last Name:BRIDGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARLECH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2508
Mailing Address - Country:US
Mailing Address - Phone:610-517-4535
Mailing Address - Fax:
Practice Address - Street 1:1303 DELAWARE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3419
Practice Address - Country:US
Practice Address - Phone:610-517-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00008601041C0700X
PACW0151431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical